Single-incision Laparoscopic Appendectomy Versus Traditional 3-port Laparoscopic Appendectomy: An Analysis of Outcomes at a Single Institution

Sharon Monsivais, BA, Hannah Vassaur, MS, PAC, Daniel Jupiter, PhD, John Eckford, MD, Rob Watson, MD, F. Paul Buckley III, MD

Division of General Surgery, Scott and White Healthcare

Purpose: The largest retrospective review to date comparing single-incision laparoscopic (SILS) appendectomy and traditional 3-port laparoscopic (LAP) appendectomy was conducted to assess the safety and feasibility of the less invasive laparoscopic technique.

Methods: All SILS and LAP appendectomies performed by three surgeons at a single institution between November 1, 2008 and June 12, 2012 were reviewed. Statistical evaluation included descriptive analysis of demographic data including age and gender, as well as bivariate analyses of operative outcomes including operative time, conversions, complications, and length of hospital stay.

Results: 168 patients who underwent SILS appendectomy and 108 patients who underwent LAP appendectomy were reviewed. There was no statistically significant difference between mean SILS operative time (43.63 min) and mean LAP operative time (40.95 min) (p-value 0.29). Additionally, no statistically significant association was noted between surgical approach and length of hospital. 0.93% of LAP appendectomies and 2.38% of SILS appendectomies were converted to open, but this difference was not statistically significant according to Fisher’s Exact Test (p-value 0.65). After excluding cases converted to open, it was found that 3.66% of SILS cases were converted to multiport laparoscopy. No increase in overall complication rate was associated with SILS when compared to LAP appendectomy, which yielded five and ten cases with a post-operative complication, respectively. Wound complications for SILS appendectomy included one incisional hernia and no wound infections, while there were no hernias and two wound infections reported with LAP appendectomy.

Conclusion: SILS appendectomy is a safe and feasible alternative to traditional LAP appendectomy and can be conducted with similar operative times, length of stay, and complication rates. This review will act as a forerunner for prospective studies, which are warranted to conclusively demonstrate equivalence of operative times, complications, and length of hospital stay, as well as elucidate differences in patient-centered outcomes, including post-operative pain, cosmesis, and quality of life.

Session: Poster Presentation

Program Number: P477

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